A Prospective Study on the lncidence of Ventilator-associated Pneumonia in Patients with Circuit Changes every 3 days Versus Weekly Changes / 병원감염관리

BACKGROUND: Ventilator associated pneumonia (VAP) is the most serious nosocomial infection of intensive care units. Several studies have investigated the relationship between the interval of ventilator circuit changes and the incidence of pneumonia in foreign countries, but there are no reports about it in Korea yet. So we performed this study to compare the clinical and cost impact between 3 days and 7 days interval in ventilator circuit changes. METHODS: Seoul National University Hospital is a 1,500-bed, university affiliated, tertiary and acute care hospital. All patients admitted to medical intensive care unit (MICU) and surgical intensive care unlt (SICU) between April 1, 1998 and October 31, 1998, requiring mechanical ventilation were included. Patients were divided into two groups of a-cay circuit changes and weekly changes. Daily surveillance was conducted using the criteria of VAP of the National Nosocomial Infection Surveillance System. Incidence of VAP and risk factors for VAP were evaluated. Standard microbiologic methods were used for the identification of clinical and environmental isolates. Statistical analysis was done by SAS Program (version 6.12), analysis of difference in variables was performed using chi-square test and t-test. Analysis of odds ratios was done with logistic regression analysis. RESULTS: VAP developed at a rate of 12.2 per 1,000 ventilator-days in the 3 days change group and 15.6 per 1,000 ventilator-days in the weekly change group (P=0.7240). The only statistically significant risk factor of VAP was duration of mechanical ventilation, The risk of VAP in patients with more than 7 days was 2.23 times higher than in patients with 7 days and below (OR; 2.2296). Estimated annual savings of nursing time by extending ventilator circuit change interval from 3 days to 7 days were 26,806 min 48 sec and estimated savings of cost by reduction of nursing times was calculated as 6,701,700 won. CONCLUSIONS: Weekly ventilator circuit changes in patients undergoing ventilation therapy in the ICU do not contribute to increased the rates of VAP and are cost-effective.

Outbreak Investigation of Epidemic Keratoconjunctivitis in a Neonatal Intensive care Unit / 병원감염관리

BACKGROUND: This was concerned with outbreak investigation of the epidemic keratoconjunctivitis (EKC) which occurred from April to May 1996 in the neonatal intensive care unit (NICU) of Seoul National University Hospital in Seoul, Korea. METHOD: We defined the cases by the clinical signs and symptoms and investigated the possible risk factors of this outbreak by case-control analysis. RESULTS: The number of total cases were 17, including neonates (10 cases) and health care workers (7 cases), The index case was thought to be infected by his family, while the other cases may have been transmitted through contact with nurses who cared for or fed the index case. There were no statistically significant differences between case and non-case (control) neonates. However, for nurses, the total amounts of time spent working in the hospital and in the NICU were identified as significant factors. And the incidence of EKC was higher in the nurses who contacted neonates with EKC more frequently. CONCLUSION: According to our contact precautions, we enforced cohort isolation and emphasized strict hand washing and aseptic technique to the health care workers. All of the equipment, especially eye dips used by the cases, was disinfected or sterilized. Fortunately this outbreak ended after about one week when we recognized and started to investigate this outbreak.